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Immunology Laboratory at “Nadezhda” Hospital
Interview with Prof. Snezhina Mihaylova, Head of the Immunology Laboratory at “Nadezhda” Hospital:
“In medicine, there are places where you simply work, and places where you feel you are exactly where you should be. ‘Nadezhda’ belongs to the second type. Patients come here with long histories—often with many questions and few answers. This is an environment where immunology is not a luxury, but a necessity.”
16.02.2026 | 14:43
The Immunology Laboratory at “Nadezhda” Hospital is a highly specialized unit for consultations and diagnostic testing focused on immunotherapy monitoring and control. It supports patients with reproductive difficulties, pregnant women with autoimmune diseases, as well as individuals with congenital and acquired immunodeficiency conditions.
We speak with Prof. Snezhina Mihaylova, Head of the Immunology Laboratory at MBAL “Nadezhda,” about the essence of her work, the challenges, and the opportunities within the laboratory.
“In medicine, there are places where you simply work, and places where you feel you are exactly where you should be. ‘Nadezhda’ belongs to the second type. Patients come here with long histories—often with many questions and few answers. This is an environment where immunology is not a luxury, but a necessity.”
Prof. Mihaylova graduated in Medicine in 1999 from Medical University of Sofia. She obtained her specialty in Clinical Immunology in 2006 and earned a PhD in 2007 with research on the immunogenetics of multiple sclerosis.
Since 2016, she has been an Associate Professor, and since 2024, a Professor at the Department of Clinical Immunology at Medical University of Sofia, with extensive teaching experience.
She specialized in immunology and molecular diagnostics at:
- Northern Ireland Tissue Typing Laboratory
- City Hospital Belfast
- University of Nottingham
- Vall d’Hebron University Hospital
Her research focuses on immune deficiencies, chronic inflammatory diseases, infections, neurodegenerative disorders, transplantation, autoimmune diseases, and reproductive immunological disorders.
She has over 100 publications and has participated in scientific projects both nationally and internationally. With more than 20 years of clinical experience, she specializes in diagnosing, treating, and monitoring patients with immune system-related disorders, including reproductive failures.
She is a member of the Board of the Bulgarian Association of Clinical Immunology, as well as:
- European Society for Immunodeficiencies
- European Federation for Immunogenetics
- Bulgarian Society of Human Genetics and Genomics
She also contributes to the development of medical procedures, standards, and healthcare guidelines for institutions and governing bodies.
1. Prof. Mihaylova, in 2025 you took over the leadership of the Immunology Laboratory at “Nadezhda” Hospital. How do you feel here?
Immunology is not a loud specialty. It does not enter the room with a diagnosis, but with a question.
At “Nadezhda,” I feel I am in a place where those questions are not only allowed—they are expected. This is a hospital where we are not afraid to say, “there is something more here.” For an immunologist, that is the right environment.
Formally, I have been at “Nadezhda” for three months. But honestly, it feels much longer. The reason is simple: for years I have worked with exactly this type of patient, these kinds of problems, and the technologies we now apply here.
The real value lies in understanding the mechanism and being able to influence it in a targeted way. That is exactly what becomes possible here.
The Immunology Laboratory at “Nadezhda” offers a level of integrated diagnostics and therapeutic planning that is currently unmatched in Bulgaria—and in many respects, beyond it.
It is not just about tests, but about a comprehensive approach—from highly specialized immunological investigations, through clinical interpretation, to participation in real treatment decisions, especially in reproductive medicine.
That is what makes me feel at home: the ability to work with a team and infrastructure that allow immunology to become not an endpoint, but a bridge—between diagnosis and hope for measurable results.
2. What does the work of the Immunology Laboratory actually involve, and what are today’s challenges?
Our work is not simply to measure indicators. We try to understand behavior. The immune system rarely fails dramatically—it makes subtle deviations that over time lead to major consequences. The challenge today is that patients often arrive after a long journey, with the feeling that “everything seems normal, but nothing works.” Frequently, the cause lies in immune cells and immune regulation in the context of conception and pregnancy.
The laboratory performs specialized immunological investigations related to implantation and pregnancy maintenance—analysis of cells and their subpopulations, their balance, autoantibodies, immunogenetics, and interpretation of these findings in direct connection with the clinical picture and reproductive history.
At “Nadezhda,” these investigations do not exist in isolation—they are part of an integrated model in which immunology supports real therapeutic decisions. The greatest challenge remains balancing scientific evidence with the individual needs of each patient. That is the strength of the Immunology Laboratory at “Nadezhda”: transforming complex immunology from abstract theory into a practical tool that supports the path from diagnosis to real clinical outcomes.
3. Which departments in the hospital do you work most closely with, and what does the patient gain from this?
We work most intensively with colleagues in assisted reproduction, obstetrics and gynecology, endocrinology, clinical laboratory medicine, genetics, pathology, and intensive care.
The benefit for the patient is clear: when specialists do not work in fragments, but as a team, diagnosis comes faster and treatment becomes more precise. Immunology cannot exist in isolation—it is part of a much larger story.
4. How is the laboratory technically equipped?
The Immunology Laboratory at MBAL “Nadezhda” is equipped with high-technology instrumentation that allows comprehensive and in-depth evaluation of the immune system—from molecular to cellular and tissue-level analyses.
A key instrument is flow cytometry, which enables precise quantitative and functional analysis of immune cells and their subpopulations. Through this method, NK cells, T- and B-lymphocytes, regulatory and effector populations are studied, as well as clinically relevant ratios associated with implantation and pregnancy maintenance.
The laboratory also offers molecular diagnostics, allowing deeper understanding of alloimmune mechanisms that cannot be assessed through routine testing.
Another essential component is the use of modern immunohistological methods for tissue analysis, including endometrial samples. These allow evaluation of the local immune environment—critical for successful implantation—something that cannot be determined through peripheral blood analysis alone.
5. What types of tests are performed, and can only “Nadezhda” patients access them?
We perform a broad range of immunological investigations—for reproductive problems, autoimmune diseases, immunodeficiencies, and chronic inflammatory conditions. The laboratory is also open to external patients. What matters is not where the patient comes from, but why they come.
6. Which patient groups do you work with most actively?
Women and couples with reproductive difficulties, patients with recurrent miscarriages, individuals with autoimmune diseases, and those suspected of having immune deficiencies. These are often patients for whom standard medicine has already provided all the “obvious” answers—yet something is still unresolved.
7. What are the most common immunological problems you encounter?
I see more imbalances than classic diseases. The immune system is active—but not in the right way. The issue is not whether it works, but how it works.
Common reproductive immunology problems include imbalance of key immune cells in peripheral blood and endometrium, creating an inflammatory environment unfavorable for implantation or pregnancy development.
We also frequently encounter alloimmune incompatibilities between mother and embryo, as well as subclinical autoimmune processes such as thyroid autoantibodies and antiphospholipid antibodies.
Often, these issues are combined, and their significance must be assessed individually in order to provide targeted therapy.
8. When should someone with fertility difficulties consult an immunologist?
When there are recurrent failures, unexplained infertility, or repeated miscarriages. The immunologist is not the first stop—but often the place where the story finally starts to make sense.
9. How often is the immune system behind recurrent miscarriages?
Not always—but more often than we think. Especially when losses recur and no other clear cause is identified. Immunological causes are found in approximately 20–30% of recurrent miscarriage cases, particularly when genetic, anatomical, or hormonal causes have been excluded.
Early detection allows targeted therapy and significantly increases the chances of a successful pregnancy.
10. What is the role of the immunologist during pregnancy?
Pregnancy is an immunological condition. In cases of autoimmune disease, complications, prior losses, or high-risk pregnancy, the immunologist helps maintain balance. They monitor both cellular and humoral immune parameters to prevent immune reactivation or maternal-fetal conflict.
They also coordinate therapy with gynecologists and reproductive specialists, including the use of immunomodulatory treatments when needed. This ensures an optimal immune environment for pregnancy without compromising maternal defense.
11. Are autoimmune diseases difficult to diagnose?
Yes—because they begin quietly. One test does not establish a diagnosis. Diagnosis is a process of observation, logic, and sometimes patience.
Autoimmune diseases are often diagnosed with significant delay—on average 3 to 7 years, and in some rare forms, even longer. Early intervention is crucial, as timely identification improves prognosis and reduces complications.
12. Do autoimmune diseases affect quality of life?
Strongly—especially if they remain unrecognized. Fatigue, pain, and reproductive problems rarely come alone. But with proper monitoring, quality of life can remain good.
13. Can autoimmune diseases be treated?
Autoimmune diseases are generally not “cured” in the classical sense, but they can be effectively controlled. The goal is remission and stability, minimizing flare-ups and protecting organ function.
Modern approaches include targeted biological therapies, such as inhibitors of TNF-α, IL-6, and other cytokines involved in pathological inflammation. This allows more precise immune control with fewer side effects. Even with autoimmune disease, safe conception and successful pregnancy are possible with the right individualized approach.
14. What advice would you give patients regarding immune system problems?
Do not ignore the signals your body gives you. Seek professional help in time.
Trust between patient and physician is essential—only when a person feels heard and understood can immunological diagnostics and therapy be truly effective. At “Nadezhda,” immunology stops being an abstract science and becomes a practical tool for real results.
